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Home My WebLink AboutContract 57472-FP2 (2)FORT WORTHa City Secretary -FP2 Contract No. 57472 Date Received 03/25/2024 AT NOTICE OF PROJECT COMPLETION (Developer Projects) The Transportation and Public Works Department upon the recommendation of the Project Manager has accepted the following project as complete: Project Name: Cohix Phase 1 City Project No.: 103287 Improvement Type(s): Water x❑ Original Contract Price: Water Original Contract Price: Sewer Original Contract Price Total Approved Change Order: Water Approved Change Order: Sewer Revised Contract Amount: Water Revised Contract Amount: Sewer Total Cost of Work Complete: Contractor Vice President Title Burnsco Construction INC Company Name —L-1� .1ham Fauver (Mar 20, 202413:06 CDT) Project Inspector Khai Taa-Fi i P. E. Khal Jaafari P.E.(Mar 24. 202423:50 CDT) Project Manager Raharra 0,—/ (MAr JS Jf1J4 OR-06 CDT) CFA Manager Sewer x❑ Dev Costs $1,076,386.89 $1,165,072.00 $2,241,458.89 $2,000.00 $1,490.00 $1,078,386.89 $1,166, 562.00 $2,244,948.89 City Costs $60,234.31 $0.00 $60,234.31 $0.00 $0.00 $60,234.31 $0.00 $60,234.31 M a r 20, 2024 Date Mar 20, 2024 Date M a r 24, 2024 Date M a r 25, 2024 Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Total Cost $1,136,621.20 $1,165, 072.00 $2,301,693.20 $2,000.00 $1,490.00 $1,138, 621.20 $1,166, 562.00 $2,303,183.20 Page 1 of 2 r— 202408�CD7 Mar 25, 2024 TPW Director Date 0�� M a r 25, 2024 Asst. City Manager Date Notice of Project Completion Project Name: Cohix Phase 1 City Project No.: 103287 City's Attachments Final Pay Estimate ❑x Change Order(s): ❑x Yes ❑ N/A Pipe Report: x❑ Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid ;'' Consent of Surety 0 Statement of Contract Time Contract Time: 280 WD Days Charged: 369 Work Start Date: 6/13/2022 Work Complete Date: 1/31/2024 Completed number of Soil Lab Test: 750 Completed number of Water Test: 18 Page 2of2 FoRTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name COHIX PHASE 1 Contract Limits Project Type WATER & SEWER City Project Numbers 103287 DOE Number 3287 Estimate Number 1 Payment Number 1 City Secretary Contract Number Contract Date 2/2/2022 For Period Ending 1/31/2024 WD Contract Time 15WD Days Charged to Date 369 Project Manager NA Contractor BURNSCO CONSTRUCTION, INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 Inspectors E. DAVILA / W. FAUVER Contract is 100.00 Complete Thursday, February 15, 2024 Page 1 of 5 City Project Numbers 103287 Contract Name COHIX PHASE 1 Contract Limits Project Type WATER & SEWER Project Funding UNIT 1A: WATER IMPROVEMENTS Item Description of Items Estimated Unit No. Quanity 1 8" PVC WATER PIPE 7044 LF 2 FIRE HYDRANT W/GATE VALVE 7 EA 3 1" WATER SERVICE 166 EA 4 8" GATE VALVE & BOX 27 EA 5 TRENCH SAFETY 7044 LF 6 CONNECTION TO EXISTING 36" WATER MAIN 1 EA 7 DUCTILE IRON WATER FITTINGS 0.9 TN W/RESTRAINT 8 2" WATER SERVICE 1 EA 9 1" IRRIGATION SERVICE 4 EA 10 36" X 8" TAPPING SLEEVE & VALVE 1 EA 11 8" WATERLINE LOWERING 20 EA 12 1 1/2" IRRIGATION SERVICE (CO#1) 1 EA Sub -Total of Previous Unit UNIT 111: 16" WATER IMPROVEMENTS (MCPHERSON Item Estimated Description of Items Unit No. Quanity 1 16" WATER PIPE 1356 LF 2 16" GATE VALVE & BOX 2 EA 3 CONNECTION TO EXSING 36" WATER MAIN 1 EA 4 DUCTILE IRON WATER FITTINGS 0.2 TN W/RESTRAINT 5 TREENCH SAFETY 6 TRAFFIC CONTROL 7 2" COMBINATION AIR RELEASE ASSEMBLY FOR WATER DOE Number 3287 Estimate Number 1 Payment Number 1 For Period Ending 1/31/2024 Unit Cost Estimated Completed Completed Total Quanity Total $59.70 $420,526.80 7044 $420,526.80 $5,020.00 $35,140.00 7 $35,140.00 $1,140.00 $189,240.00 166 $189,240.00 $1,630.00 $44,010.00 27 $44,010.00 $0.10 $704.40 7044 $704.40 $1,800.00 $1,800.00 1 $1,800.00 $6,600.00 $5,940.00 0.9 $5,940.00 $2,760.00 $2,760.00 1 $2,760.00 $1,200.00 $4,800.00 4 $4,800.00 $9,000.00 $9,000.00 1 $9,000.00 $4,220.00 $84,400.00 20 $84,400.00 $2,000.00 $2,000.00 1 $2,000.00 $800,321.20 $800,321.20 Unit Cost Estimated Completed Completed Total Quanity Total $174.50 $236,622.00 1356 $236,622.00 $19,000.00 $38,000.00 2 $38,000.00 $1,800.00 $1,800.00 1 $1,800.00 $9,000.00 $1,800.00 0.2 $1,800.00 1356 LF $0.50 $678.00 1356 $678.00 1 MO $1,600.00 $1,600.00 1 $1,600.00 1 EA $10,100.00 $10,100.00 1 $10,100.00 8 IMPORTED EMBEDMENT/BACKFILL CSS 100 LF $24.00 $2,400.00 100 $2,400.00 9 36" X16" TAPPING SLEEVE & VALVE 1 EA $9,800.00 $9,800.00 1 $9,800.00 10 16" WATER LINE LOWERING 5 EA $7,100.00 $35,500.00 5 $35,500.00 Sub -Total of Previous Unit $338,300.00 $338,300.00 Thursday, February 15, 2024 Page 2 of 5 City Project Numbers 103287 DOE Number 3287 Contract Name COHIX PHASE 1 Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER & SEWER For Period Ending 1/31/2024 Project Funding UNIT H: SANITARY SEWER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 8": SEWER MAIN 8706 LF $69.00 $600,714.00 8706 $600,714.00 2 10" SEWER PIPE 326 LF $80.00 $26,080.00 326 $26,080.00 3 4'MANHOLE 32 EA $3,900.00 $124,800.00 32 $124,800.00 4 EXTRA DEPT MANHOLE (> 6.0') 149 VF $170.00 $25,330.00 149 $25,330.00 5 4" SEWER SERVICE (CO #1) 167 EA $1,490.00 $248,830.00 167 $248,830.00 6 POST -CCTV INSPECTION 9032 LF $3.00 $27,096.00 9032 $27,096.00 7 MANHOLE VACUUM TESTING 32 EA $130.00 $4,160.00 32 $4,160.00 8 TRENCH SAFETY 9032 LF $1.00 $9,032.00 9032 $9,032.00 9 TRAFFIC CONTROL 1 MO $500.00 $500.00 1 $500.00 10 EPDXY MANHOLE LINER 153 VF $350.00 $53,550.00 153 $53,550.00 11 IMPORTED EMBEDMENT/BACKFILL CSS 550 LF $51.00 $28,050.00 550 $28,050.00 12 CONNECT TO EXISTING MANHOLE 1 EA $2,100.00 $2,100.00 1 $2,100.00 13 8" SEWER PIPE SELECT BACKFILL 320 LF $51.00 $16,320.00 320 $16,320.00 Sub -Total of Previous Unit $1,166,562.00 $1,166,562.00 Thursday, February 15, 2024 Page 3 of 5 City Project Numbers 103287 Contract Name COHIX PHASE 1 Contract Limits Project Type WATER & SEWER Project Funding Contract Information Summary Original Contract Amount Chanhe Orders Change Order Number 1 Change Order Number 1 DOE Number 3287 Estimate Number 1 Payment Number 1 For Period Ending 1/31/2024 $2,301,693.20 $2,000.00 $1,490.00 Total Contract Price $2,305,183.20 Total Cost of Work Completed $2,305,183.20 Less % Retained $0.00 Net Earned $2,305,185.20 Earned This Period $2,305,185.20 Retainage This Period $0.00 Less Liquidated Damages Days @ / Day LessPavement Deficiency Less Penalty Less Previous Payment Plus Material on Hand Less 15% Balance Due This Payment $0.00 $0.00 $0.00 $0.00 $0.00 $2,305,185.20 Thursday, February 15, 2024 Page 4 of 5 City Project Numbers 103287 Contract Name COHIX PHASE 1 Contract Limits Project Type WATER & SEWER Project Funding Project Manager NA Inspectors E. DAVILA / W. FAUVER Contractor BURNSCO CONSTRUCTION, INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 DOE Number 3287 Estimate Number 1 Payment Number 1 For Period Ending 1/31/2024 City Secretary Contract Number Contract Date 2/2/2022 Contract Time 150 WD Days Charged to Date 369 WD Contract is .000000 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded Total Cost of Work Completed $2,305,183.20 Less % Retained $0.00 Net Earned $2,305,185.20 Earned This Period $2,305,185.20 Retainage This Period $0.00 Less Liquidated Damages 0 Days @ $0.00 / Day $0.00 LessPavement Deficiency $0.00 Less Penalty $0.00 Less Previous Payment $0.00 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $2,305,185.20 Thursday, February 15, 2024 Page 5 of 5 PROJECT NAME: CONTRACT: CFA # CITY PROJECT # DOE # FID # FILE # INSPECTOR: PROJECT MANAGER: ORIGINAL CONTRACT EXTRAS TO DATE CREDITS TO DATE CONTRACT TO DATE AMOUNT OF PROP. CHANGE ORDER REVISED CONTRACT AMOUNT TOTAL REVISED CONTRACT AMOUNT PER UNIT REVISED COST SHARE TOTAL REVISED CONTRACT DEVELOPER -AWARDED -PROJECT CHANGE ORDER Cohix Ph 1 A - Water, Sewer, Drainage B - Paving C - Street Lights 21-0144 103287 30114-0200431-103287-EO7685 X-26892 Troy Gardner Khal Jaafari CITY PARTICIPATION: Yes Phone No: 682-215-8720 Phone No: 817-392-7872 CHANGE ORDER No: Al, 131, C1 RECEIVED By Khal Jaafari at 12:11 am, Aug 23, 2022 CONTRACT UNIT WATER I SEWER I PAVING I DRAINAGE �evelo STREET LIGHTS CONTRACT er DAYS Developer Cost City Cost Developer Cost I City Cost (Developer Cost City Cost (Developer Cost I City Cost Cost City Cost $1,076,386.89 $60,234.31 $1,165,072.00 I I $1,393,061.40 I $1,216,275.00 I $116,848.80 I 225 WD $1,076,386.89 $60,234.31 $1,165,072.00 I $0.00 $1,393,061.40 $0.00 I $1,216,275.00 I $0.00 $116,848.80 $0.00 I 225 WD $2,000.00 $1,490.00 I $114,101.00 I I $160.20 $1,078,386.89 $60,234.31 $1,166,562.00 I $0.00 $1,507,162.40 $0.00 I $1,216,275.00 I $0.00 $117,009.00 $0.00 I 225 WD $1,138,621.20 I $1,166,562.00 I $1,507,162.40 I $1,216,275.00 $117,009.00 Dev. Cost: $5,085,395.29 City Cost: $5,145,629.60 Revised: 10-12-2011 Page 1 You are directed to make the following changes in the contract docum nts CITY BID ITEM PAY ITEM # # QUANTITY UNIT 12 9999.0000 1 EA You are directed to make the following changes in the contract docum nts CITY BID ITEM PAY ITEM # # QUANTITY UNIT 5 3331.3101 1 EA You are directed to make the following changes in the contract docur"gnts CITY BID ITEM PAY ITEM # # QUANTITY UNIT 3 3211.0501 -0.40 SY 4 3211.0502 0.40 SY 5 32 11 .0400 0.14 TON 6 3213.0301 0.015 SF You are directed to make the following changes in the contract documents CITY BID ITEM PAY ITEM # # QUANTITY UNIT 2 3211.0502 -0.1 SY 3 3211.0400 0.358 TON 14 3292.0100 3695 SY 15 3291.0100 616 CY You are directed to make the following changes in the contract docum nts CITY BID ITEM PAY ITEM # # QUANTITY UNIT 1 2605.3015 9 LF 2 3441.1410 9 LF RECEIVED By Khal Jaafari at 12:11 am, Aug 23, 2022 UNIT IA: WATER IMPROVEMENTS ITEM DESCRIPTION UNIT PRICE TOTAL 1 1/2" Irrigation Service $2,000.00 $2,000.00 I TOTAL $2,000.00 I UNIT /I: SANITARY SEWER IMPROVEMENTS ITEM DESCRIPTION UNIT PRICE TOTAL 4" Sewer Service $1,490.00 $1,490.00 I TOTAL $1,490.00 I UNIT IV., PAVING IMPROVEMENTS ITEM DESCRIPTION UNIT PRICE TOTAL 6" Lime Treatment $3.10 -$1.24 8" Lime Treatment $3.65 $1.46 I Hydrated Lime $180.00 $25.20 I 4" Conc Sidewalk $5.75 $0.09 I TOTAL $25.51 UNIT V. OFFSITE PAVING IMPROVEMENTS ITEM DESCRIPTION UNIT PRICE TOTAL 8" Lime Treatment $3.25 -$0.33 I Hydrated Lime $180.00 $64.44 Block Sod Placement $16.38 $60,524.10 I Topsoil $86.83 $53,487.28 I TOTAL $114,075.50 I UNIT VI., STREET LIGHTING IMPROVEMENTS ITEM DESCRIPTION UNIT PRICE TOTAL 2" CONDT PVC SCH 80(T) $13.68 $123.12 NO 10 Insulated Elec Condr $4.12 $37.08 I TOTAL $160.20 REASONS FOR CHANGE ORDER Added missing bid items, adjusted rounding error in paving quantities, shifted streetlight to avoid driveway. Revised: 10-12-2011 Page 2 DocuSign Envelope ID: FF7E3867-E92B-491 E-9856-8D797C361 F42 RECOMMENDED: By: Shield Engineering Group. PLLC Name - Title: UI4_0 Pj{9!5dpEw'r RECEIVED By Khal Jaafari at 12:12 am, Aug 23, 2022 APPROVED: DocuSigned by: By: COCBFA60CF51 tar SUSA Realstate Group, Inc. Name: 4F0... Tape: Vice Presi dent APPROVED: By: Bu sCq Construction, Inc — Name: Tite: Vice President By: Gitco Contracgng. Inc Name: V C �- ✓�`'��— True: 1fi 9r�S l By: Independent U01ity Construction, Inc Name: (Z� ilk t{�G Title: President Revised: 10-12-2011 Page 3 1 0ny Wo unf TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Cohix Phase 1 CITY PROJECT NUMBER: CPN 103287 WATER PIPE LAID SIZE TYPE OF PIPE FIRE HYDRANTS: '7 PIPE ABANDONED N IA DENSITIES:L_=s NEW SERVICES: f PIPEE' LAID q PIPE ABANDONED DENSITIES: ,A NEW SERVICES: VALVES (16" OR LARGER) SIZE TYPE OF PIPE 1 Y pvc 111 Pqc- SEWER SIZE TYPE OF PIPE 1is `� I-D" e)(4-" SIZE TYPE OF PIPE TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 LF 7.6q t LF 1 L6 LA tk . 1 LF . t)4 LIP,, 2 r—, t�IV LF 11,1 •c11Gam. FORTWORTH. M, TRANSPORTATION AND PUBLIC WORKS February 8, 2024 Burnsco Construction INC INC. 6331 Southwest BLVD Benbrook TX 76132 RE: Acceptance Letter Project Name: Cohix Phase 1 Project Type: WATER,SEWER Drainage City Project No.: 104075 To Whom It May Concern: On February 8, 2024 a final inspection was made on the subject project. There were no punch list items identified at that time. The final inspection indicates that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on February 8, 2024, which is the date of the final inspection and will extend of two (2) years in accordance with the Contract Documents. If you have any questions concerning this letter of acceptance, please feel free to contact me at Khal Jaafari. 817-392-7872. Sincerely, Khal Taafari P.E. Khal Jaafari P.E.(Mar24, 202423:50 CDT) Khal Jaafari, Project Manager Cc: William Favour, Inspector Donald Watson, Inspection Supervisor Aaron Ybarra, Senior Inspector Andrew Goodman, Program Manager Shield Engeering, Consultant Burnsco Construction INC., Contractor Forestar, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 08/20/19 AFFIDAVIT STATE OF TEXAS COUNTY OFTARRANT Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Ab Grantges, Contract Mgr, Of Burnsco Construction, known to me to be a credible person, who being by me duly sworn, upon his oath deposed and said; That all persons, firms, associations, corporations, or other organizations furnishing labor and/or materials have been paid in full; That the wage scale established by the City Council in the City of Fort Worth has been paid in full; That there are no claims pending for personal injury and/or property damages; On Contract described as; Cohix Phase 1 - Water, Sanitary Sewer and Storm Drain BY 4b GrantgesContract Manager Subscribed and sworn before me on this date 20th of February, 2024. Notary Public Tarrant County, Texas �"Yp % KASSAND9A CANALES Notary Public, State of Texas �,•'�= Corsim. Expires 01-23-2027 Notary ID 134158873 g1Hn�„ �+ CONSENT OF SURETY COMPANY TO FINAL PAYMENT Conforms with the American Institute of Architects, AIA Document G707 OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER Bond No 022232664 PROJECT: (name, addresS)Cohix Phase 1 (Terra Trace) - Water, Sanitary Sewer and Drainage TO (Owner) Fort Worth TX FORESTAR (USA) REAL ESTATE GROUP, INC. AND ARCHITECT'S PROJECT NO: CITY OF FORT WORTH CONTRACT FOR: 14755 Preston Road, Suite 130 Cohix Phase 1 (Terra Trace) - Water, Sanitary Sewer and Drainage Improvements Dallas TX 75254 --J CONTRACT DATE: CONTRACTOR: BURNSCO CONSTRUCTION, INC. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 , SURETY COMPANY on bond of (here insert name and address of Contractor) BURNSCO CONSTRUCTION, INC. 6331 Southwest Boulevard Benbrook TX 76132 ,CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Owner) FORESTAR (USA) REAL ESTATE GROUP, INC. AND CITY OF FORT WORTH 14755 Preston Road, Suite 130 Dallas TX 75254 , OWNER, as set forth in the said Surety Company's bond. IN WITNESS, WHEREOF, the Surety Company has hereunto set its hand this Attest: (Seal): 20th day of February, 2024 LIBERTY MUTUAL INSURANCE COMPANY Surety Company N44-W Signature of Authorized Representative SoDhinie Hunter Attorney -in -Fact Title NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition ONE PAGE This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Liberty Mutual Insurance Company Mutual. The Ohio Casualty Insurance Company Certificate No: 8205467-022020 SURETY West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Don E. Cornell, Joshua Saunders; Kelly A. Westbrook; Mikaela Peppers; Ricardo J. Reyna; Robbi Morales; Sophinie Hunter; Tina McEwan; Tonic Petranek all of the city of Dallas state of TX each individually if there be more than one named, its true and lawful attomey-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 23rd day of April 2021 Liberty Mutual Insurance Company P� 1NSu/q POSY INS& a 1NShgq The Ohio Casualty Insurance Company �o uDRPDRgr Ln 5J GORPDRgT 9ym `VQ �oRPORgr 2n West American Insurance Company f w 3 Fo rn vi Y;1912y0 oy1919�0 a. 1991 0 /�7 ct�E rd�9s`rACHU9�.da yO MPsa� `e, �ND10"' a 4Cr r ,! .� U NA 9,7 * tiP dyl * ��d s�,M * ��d By. , e — M David M. Carey, Assistant Secretary Cr m State of PENNSYLVANIA ss m rn County of MONTGOMERY o E 4- 3 On this 23rd day of April 2021 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance M Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes E therein contained by signing on behalf of the corporations by himself as a duly authorized officer. > c IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. N M p, PAS 0-0 o �`C Commonwealth of Pennsylvania - Notary Seal A_ N r t,� Teresa Pastella, Not Public C -Fa +-•0 a) '' .T Montgomery County ` +-aF" My commission expires March 28, 2025 By.7ereAP ,[,wpc.� .(J � O N N 'Ys.5Y1`+��MemSeLPennfssion sylvanaumber AssocatonorNolaries saastella, Notary Public Q O f� N �W `O � This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 3 E•� Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: li M 00 ARTICLE IV- OFFICERS: Section 12. Power of Attorney. o 0 C� Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the -a L) President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety CO C > any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall a ME have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such o Iv Z 0 instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the f m provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ti Q. ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. _ IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 20th day of February 2023 P� \NSUpq P'ZY INS& N \NS(/Rq tiJ ooRPoRvr 4- yJ 4oRPDR°T 92 \GPGoRvoRgr'. J �= FO in VQ ? Fa m W .� FO 1912 oy1919�o a 1991 0 �',�19s'S4CHU6��.da SONA MPS�`� a Y �NDa3 By: IANP' *aa Renee C. Llewellyn, Assistant Secretary LMS-12873 LMIC OCIC WAIC Multi Co 02/21 TEXAS IMPORTANT NOTICE To obtain information or make a complaint: You may call toll -free for information or to make a complaint at 1-877-751-2640 You may also write to: 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at 1-800-252-3439 You may write the Texas Department of Insurance Consumer Protection (I I I-1A) P. O. Box 149091 Austin, TX 78714-9091 FAX: (512) 490-1007 Web: http://www.tdi.texas.gov E-mail: ConsumerProtection4,tdi.texas.gov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should first contact the agent or call 1-800-843-6446. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. NP 70 68 09 01 LMS-15292 10/15 TEXAS AVISO IMPORTANTE Para obtener informacion o para someter una queja: Usted puede llamar al numero de telefono gratis para informacion o para someter una queja al 1-877-751-2640 Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quejas al 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas Consumer Protection (I I I -1 A) P. O. Box 149091 Austin, TX 78714-9091 FAX # (512) 490-1007 Web: htto://www.tdi.texas.uov E-mail: ConsumerProtection4a.tdi.texas.gov DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiena una disputa concerniente a su prima o a un reclamo, debe comunicarse con el agente o primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TDI) UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto.